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Coronary
Artery Bypass
Bypass surgery is the most common type
of heart surgery. More than 300,000 people have successful
bypass surgery in the United States each year. In India,
this number is approximately 100,000 each year.
Arteries can become clogged over time
by the buildup of fatty plaque. Bypass surgery improves the
blood flow to the heart with a new route, or "bypass,"
around a section of clogged artery. |
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The surgery involves sewing a section
of vein from the leg or artery from the chest or another
part of the body to bypass a part of the diseased coronary
artery. This creates a new route for blood to flow, so that
the heart muscle will get the oxygen-rich blood it needs to
work properly.
During bypass surgery, the breastbone
(sternum) is divided, the heart is stopped, and blood is
passed through a heart-lung machine. Unlike other forms of
heart surgery, the chambers of the heart are not opened
during the operation.
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What to Expect
The operation will usually be
scheduled at a time that is best for you and your surgeon,
except in urgent cases. As the date of your surgery gets
closer, be sure to tell your surgeon and cardiologist about
any changes in your health. If you have a cold or the flu,
this can lead to infections that may affect your recovery.
Be aware of fever, chills, coughing, or a running nose. Tell
the doctor if you have any of these symptoms.
Also, remind your cardiologist and
surgeon about all of the medicines you are taking,
especially any over-the-counter medicines such as aspirin or
those that might contain aspirin. You should make a list of
the medicines and bring it with you to the hospital.
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It is always best to get complete
instructions from your cardiologist and surgeon about the
procedure, but here are some basics you can expect as a
bypass patient.
Before the
Hospital Stay
Most patients are admitted to the
hospital the day before surgery. The night before surgery,
you will be asked to bathe to reduce the amount of germs on
your skin. After you are admitted to the hospital, the area
to be operated on will be shaved, washed and scrubbed with
antiseptic.
A medicine (anesthetic) will make you
sleep during the operation. This is called "anesthesia."
Because anesthesia is safest on an empty stomach, you will
be asked not to eat or drink after midnight the night before
surgery. If you do eat or drink anything after midnight, it
is important that you tell your anesthesiologist and
surgeon.
If you smoke, your doctor will want
you to stop at least 2 weeks before your surgery. Smoking
before surgery can lead to problems with blood clotting and
breathing.
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Day of Surgery
Before surgery, you may have to have
an electrocardiogram (ECG or EKG), blood tests, urine tests,
and a chest x-ray to give your surgeon the latest
information about your health. You will be given something
to help you relax (a mild tranquilizer) before you are taken
into the operating room.
Small metal disks called electrodes
will be attached to your chest. These electrodes are
connected to an electrocardiogram machine, which will
monitor your heart's rhythm and electrical activity. You
will receive a local anesthetic to numb the area where a
plastic tube (called a line) will be inserted in an artery
in your wrist. An intravenous (IV) line will be inserted in
your vein. The IV line will give you the anesthesia during
the operation.
After you are completely asleep, a
tube will be inserted down your windpipe and connected to a
machine called a respirator, which will take over your
breathing. Another tube will be inserted through your nose
and down your throat, into your stomach. This tube will stop
liquid and air from collecting in your stomach, so you will
not feel sick and bloated when you wake up. A thin tube
called a catheter will be inserted into your bladder to
collect any urine produced during the operation.
A heart-lung machine is used for most
bypass operations. A perfusion technologist or blood-flow
specialist operates the machine. Before you are hooked up to
this machine, a blood-thinning medicine called an
anticoagulant (heparin) will be given to prevent your blood
from clotting. The surgical team is led by the
cardiovascular surgeon and includes other assisting
surgeons, an anesthesiologist, and surgical nurses.
After you are hooked up to the
heart-lung machine, your heart is stopped and cooled.
A long piece of vein from your leg
(the saphenous vein) may be removed. This piece of vein is
called a graft. One end of the graft will be attached to the
ascending aorta, the large artery that carries oxygen-rich
blood out of the top of the heart to the body. The other end
of the graft will be attached to a coronary artery below the
blocked area. The surgeon may choose to use an artery from
the inside of your chest wall (the internal mammary artery)
instead. Or the surgeon may use both your vein and artery.
The procedure can take from 2 to 6 hours, depending on the
number of bypasses needed.
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Recovery Time
You can expect to stay in the hospital
for about a week, including at least 1 to 3 days in the
Intensive Care Unit (ICU) or Recovery Room (RR).
Life After
Bypass
After bypass surgery, you should limit
the fat and cholesterol in your diet. Your doctor may
recommend walking or swimming to get your strength back.
Your doctor may also recommend that you join a cardiac
rehabilitation program. These programs can help you make
lifestyle changes such as starting a new diet and exercise
program, quitting smoking, and learning to better deal with
stress.
If you have an office job, you can
usually go back to work in 4 to 6 weeks. Those who have more
physically demanding jobs may need to wait longer. In some
extreme cases, you may need to find a job that is not as
physically demanding. Twenty to 30% of bypass patients will
need a second procedure within 10 years.
WHAT NEW
PROCEDURES ARE BEING PERFORMED NOWADAYS?
Newer techniques are being explored to
improve the results and to minimize the discomfort patients
feel during recovery from CABG. One technique to improve
patient outcomes involves the use of multiple arterial
grafts - doing all bypasses with arteries like the internal
thoracic artery - and not using the saphenous vein. Because
of the positive experience with internal thoracic arteries
staying open longer than veins, cardiothoracic surgeons are
trying to do all of the bypasses with arteries with the aim
of reducing the patient's risk of needing another operation.
Another technique aimed at improving
outcomes for the patient is performing the bypass operation
without using the heart lung machine at all. During the
procedure the heart continues to do the work of pumping
blood to the body while surgeons perform the bypass
operations on the beating heart. This technique is called
Off-Pump Coronary Artery Bypass (OPCAB) and has become very
popular and safe. Other techniques in development involve
the use of smaller incisions to perform CABG. All of these
techniques are commonly referred to as "minimally invasive
surgery." In all cases the hope is that patients will have
less pain and a faster recovery and return to work.
Minimally
Invasive Bypass
Minimally invasive coronary artery
bypass surgery is done through smaller incisions. It may
involve using the mammary artery as a graft. Saphenous veins
may also be used. This procedure may be done without
stopping the heart, and some patients can even leave the
hospital within 48 hours. This operation is only used for
patients whose blockages can be bypassed through this
smaller incision and whose risk of complications is low.
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